What Is It?
First one heel hurts a little upon your first step out of bed. Next the heel hurts for a bit longer in the morning and upon first steps after sitting for a while. Then it starts hurting at the beginning of a run. Soon your heel hurts all of the time. Getting in and out of your car; anticipating standing up, causes anxiety. It’s most likely a case of Plantar fasciitis.
The plantar fascia is the thick connective tissue (aponeurosis) supporting the arch on the bottom of the foot (plantar surface). It runs from the heel bone (calcaneous) to the heads of the metatarsal bones. This band of tissue is composed of predominantly longitudinally oriented collagen fibers, with three distinct structural components: the medial component, the central component, and the lateral component.
The plantar fascia contributes to support of arch of the foot by acting as a tie-rod, where it undergoes tension when the foot bears weight. The plantar fascia also has an important role in dynamic function during gait, elongating during contact with the ground and behaving like a spring such that it becomes tense during the propulsion of the foot from the ground, helping to shorten the foot.
The pain arises when the tissue gets overly tight and any activity begins to create micro-tears, breakdown of collagen and scarring. It is the pulling on the scarred tissue, which in turn creates more damage, that causes the pain you feel – especially that horrible first step out of bed in the morning.
The causes of plantar fasciitis are not always clear. Risk factors can include overuse in anything – too much standing when you are not accustomed to it, a significant bump in running mileage, , carrying more weight, more sitting and a LACK of exercise (yes!). While the pain is felt in the heel and it may also be felt in the arch of the foot and even the Achilles Tendon, usually the real issue lies much higher in the body – the hips. Lack of hamstring strength and length combined with excessively tight hip flexors are key factors in causing many forms of foot and ankle pain, including plantar fasciitis.
While rest might seem like the best thing to do, and it can help resolve any inflammation, in the long run, it will not resolve the cause of the issue. Many times bulkier, motion-control shoes and/or orthotics are prescribed, and again, these may alleviate the immediate symptoms. They may make the foot and ankle tissues weaker and cause more problems over time, without addressing the root cause.
The Fix: a two-tiered approach
One: Address the symptom – foot pain
Get a pinky ball (dense rubber ball about 2 inches in diameter) or superball and stand on it starting at the heel of your affected foot. Roll slowly from heel to toe through all three lines of the foot – medial, central and lateral. Roll again. Roll again. This will help to ease the crankiness and work to realign the scarred tissue fibers so that they behave in a more civil fashion.
Stretch the tissue by grabbing your heel in one hand and the ball of the foot in the other (pictured). One hand, using the index finger roots the plantar tissue just behind the ball of the foot while the other hand roots and stretches the tissue at the heel bone away from the ball of the foot. This may require a massage therapist or helper.
Another stretch to try when you are in less pain is a dynamic foot stretch. Place the ball of your affected foot against a wall with your toes bent up the wall. Start with a straight leg and rotate through your foot from medial to lateral sides, keeping your toes up the wall. Next, bend your knee and repeat the motion from lateral to medial sides. Your goal is to work up to at least 3 sets of 25 reps in each position (leg straight and knee bent).
Two: Fix the cause – hip tightness/weakness
In order to overcome the issue for good, you will need to increase both hip mobility and strength. Our feet and ankles take multiple abuses throughout our lives but most act as the end of the chain, whipped around by a stronger mid-section. If there is a lack of mobility in the hips, our foots trick becomes compromised and can cause pain and dysfunction in knees, ankles and feet. A lack of hip strength can also contribute as the load of your body transfers from the point of weakness (hips) down the chain to the knees and ankles, ultimately resulting in a point of breakage.
Yoga – Yoga can help restore tissue length and strength. There are at least two types of yoga that can assist: Yin and Vinyasa. Yin Yoga is performed with “cold” muscles, holding poses for 2-4 minutes at a time. This style of yoga activates the connective tissue and restores length and mobility. Vinyasa yoga targets the muscles which may be the “cause” of the problem through tightness and weakness. Vinyasa Yoga heats and stretches the muscles, restoring length, strength and function.
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